Hemiarthroplasty versus total hip arthroplasty for femoral neck fractures in patients with chronic obstructive pulmonary disease
| Autor: | Andrew A. Tran, Danny Lee, Alice J. Hughes, Nidhi Shah, Ryan Lee, Jessica H Heyer, Rajeev Pandarinath |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Reoperation
medicine.medical_specialty Blood transfusion Arthroplasty Replacement Hip medicine.medical_treatment Population Critical Care and Intensive Care Medicine Femoral Neck Fractures Pulmonary Disease Chronic Obstructive 03 medical and health sciences Postoperative Complications 0302 clinical medicine Internal medicine Humans Medicine Orthopedics and Sports Medicine Prospective cohort study education 030222 orthopedics COPD education.field_of_study business.industry 030208 emergency & critical care medicine medicine.disease Cohort Propensity score matching Emergency Medicine Surgery Hemiarthroplasty business Complication |
| Zdroj: | European Journal of Trauma and Emergency Surgery. 47:547-555 |
| ISSN: | 1863-9941 1863-9933 |
| DOI: | 10.1007/s00068-019-01234-x |
| Popis: | This study sought to delineate whether total hip arthroplasty (THA) or hip hemiarthroplasty (HHA) had more complication rates following the treatment of femoral neck fractures (FNF) in chronic obstructive pulmonary disease (COPD) patients. The ACS-NSQIP database was queried for all patients with a history of COPD who had undergone THA and HHA with FNFs, isolated by CPT codes and ICD-9/ICD-10 codes. Propensity score matching without replacement in a 1:1 manner was done to control for patient demographics/preoperative comorbidities. Multivariate logistic regression models were utilized to assess the independent effect of HHA in comparison to THA. The propensity-matched (PM) HHA cohort was significantly older (76.14 years vs. 73.33 years, p = 0.001) and had significantly higher rates of pneumonia (p = 0.017), extended length of stay (LOS) (p = 0.017), and mortality (p = 0.002), but lower rates of blood transfusions (p = 0.016) and reoperation (p = 0.020). HHA was independently associated with an increased risk of pneumonia (p = 0.043), extended LOS (p = 0.050), and death (p = 0.044) but a decreased risk for blood transfusions (p = 0.008) and reoperation (p = 0.028) when compared to THA. Patients with more comorbidities are more likely to receive HHA than THA, which may explain some of the increased complications and mortality associated with HHA for FNFs compared to THA. Patients undergoing THA were at increased risk for blood transfusion and reoperation. THA does not appear to result in increased morbidity in this population compared to HHA. While THA should be considered in these patients given improved functional outcomes, further prospective studies are needed to establish superiority. III. |
| Databáze: | OpenAIRE |
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